Wednesday, July 11, 2012

Work for cheap in a great city.

It's odd how, in terms of doctor pay, medicine seems to work entirely differently from most other professions. Seems like friends who are lawyers or work for companies or maybe even government work to some degree make a lot more if they work in expensive cities than if they work in the middle of nowhere. People who work for prestigious law firms in Chicago or San Francisco make a lot more than people who work for small firms in suburban wherever.

But for doctors it's completely flipped. Want to work in a popular city? You're going to make perhaps a third of what you'll make if you go to an underserved location elsewhere. Want to work for a prestigious teaching hospital? You're going to make a lot less than your colleagues at a non-academic facility. You make sacrifices as far as income in exchange for what seems like a more exciting atmosphere, more diverse and interesting patients and problems, and a more in-demand place as far as location and reputation.

Not that the salaries even at the lowest end are what people would call low (although servicing the medical school debt makes the net result less high than it seems), but there's a real difference, compounded even further by the differences in cost of living. Of course, it all seems pretty astronomical compared to the resident/fellow pay scale....

6 comments:

You hit the nail on the head. That's exactly why my husband decided it would be better for us, as a family, if he kept his affiliation with the prestigious hospital he was at and move on to another hospital and help it build a department in his specialty. The difference in pay was drastic!!! We didn't even have to move!!

Part of it is simple supply and demand; as you pointed out, if an area's underserved, that facility is probably more willing to shell out extra bucks to attract and retain staff.

Another part is that more prestigious institutions are well aware of its reputation, and know that it can offer to pay a bit less in exchange for the opportunities it offers (access to research/studies/staff? an actual social life in a big city--provided still have time for that.)

My favorite are the solicitations that don't even tell you where the job is located. "Big blue sky living! Small town living with big city benefits! Great schools! Located somewhere in the mid southwest/east Rockies"

I worked in prestigious institution and frankly "opportunities" it offered cannot be offset by the abusive environment, overloading physician and staff to the point where you cannot provide safe care (not to mention quaility). A lot of my brighest peers turned down jobs in prestigious institutions. Pay is very low while you often work harder. Coupled with higher cost of living in prestigious city this is not an option for many. My attendings in prestigious institution were making exactly half of what my first job paid me. I think its just there is enough doctors in big cities whose spouses have professional high end job and can support the family. So, doctors income becomes secondary income in the family, and doctor can afford to work in Big Name Place.

Recruitment Add Translator:Add: "Country living with all the amenities of life in a big city. Within 1/2 day drive to Billings, Montana for shopping and night-life".Translation: Yeah, this place isn't even on Google maps.

Add: "Enjoy the charm of medicine at a slower pace while experiencing the second best trout fishing in the Treasure State. Revel in four spectacular seasons." Translation: Unless you trout fish, there is nothing to do here. We have 3 seasons and one excruciatingly long winter where you may wish you were dead.

Add: "Base 300K per year with potential for another 50K"Translation: "If you don't go crazy and leave after 2 months, we'll give you an extra 50 grand for finishing out the year."